轻度低氧血症的慢性阻塞性肺疾病患者的心脏结构及功能的早期变化

Early Changes of Cardiac Structure and Function in COPD Patients With Mild Hypoxemia

目的:评估正常动脉血氧分压和无右心室衰竭迹象的慢性阻塞性肺疾病(COPD)患者心脏结构和功能。方法:25个COPD稳定期的患者(FEV1,1.23±0.52L/s;PaO2,82±10mmHg),26个与研究对象年龄匹配的受试者作为对照组。以超声多普勒超声心动图测定右心室(RV)和左心室(LV)的结构与功能及检肺动脉压(PAP)。结果:COPD组与对照组右心室舒张期末直径为19±3mm,23±2mm,(P<0.01),三尖瓣口舒张期血流速度比值为1.2±0.9,1.5±0.4(P<0.05);右心室壁舒张末期厚度为4±0.9,3±0.8,(P<0.05);右心室射血分数56±12,60±11(P>0.05)。COPD组与对照组左心室舒张期直径为48.0±5.5,46.2±3.4(P>0.05);二尖瓣口舒张期血流速度比值:1.2±0.4,1.5±0.9左心室后壁厚度为10.0±0.8,10.3±0.7(P>0.05);EF斜率55.5±11.7,54.5±12.1(P>0.05);左室舒张早期最大充盈速率分数为2.83±0.43,2.81±0.45(P>0.05);左心室射血分数53±7,62±14(P>0.05);COPD组与对照组均不伴有肺动脉高压。结论:心肌肥厚是COPD患者右心室压力超负荷最早迹象,这些心脏的适应性变化不改变左右心室的收缩功能。

Objectives：To investigate the structur and function of heart in COPD patients with normal PaO2 and without signs of RV failure.Methods：The RV, left ventricular（LV） structure and function of 25 clinically stable COPD patients （FEV1,1.23 ±0.52 L/s; PaO2, 82±10 mm Hg） and 26 age-matched health person were detected by Doppler chocardiography.Pulmonary artery pressure （PAP） was detected by Doppler chocardiography.Results：The RVDD of COPD group and control group was 19±3mm and 23±2mm （P0.01）, respectively.RVFT of COPD group and control group was 4±0.9 and 3±0.8 （P0.05） , respectively;E/A is 1.2±0.9,1.5±0.4 （P0.05）and RVEF was 56±12 and 60±11 （P0.05） , respectively.The LVDD of COPD group and control group was 48.0±5.5 and 46.2 ±3.4（P0.05） , respectively; LVFT of COPD group and control group was 10.0±0.8 and 10.3±0.7（P0.05） , respectively; E/A：1.2±0.9,1.5±0.4 （P0.05）, The maximum rate of early diastolic filling fraction （PRF）：2.83±0.43,2.81±0.45 （P0.05）; LVEF was 53±7,62±14 （P0.05）; EF slope rate 55.5±11.7,54.5±12.1 （P0.05）; PAP was not elevated in the COPD group and control group.Conclusion：Concentric RV hypertrophy is the earliest sign of RV pressure overload in patients with COPD.This structural adaptation of the heart does not alterRV and LV systolic function.